Yoga and Body Dysmorphic Disorder

In every eating disorder, be it anorexia, bulemia, binge eating or anything else not otherwise categorized, there is an element of body dysmorphia. Body dysmorphia is literally not seeing what you are when you look at yourself whether its in the mirror or simply looking down at your thighs.

There are those that have Body Dysmorphic Disorder (“BDD”) related to an eating disorder (“ED”) realm, but different. Related in that both disorders have an element of anxiety – with anxiety being significantly correlated and/or comorbidly related to ED. In ED, the anxiety causes and triggers the disorder. In BDD, the anxiety IS the disorder. BDD is characterized by being excessively concerned or preoccupied with body image. In essence, when related to weight, BDD is an obsession and intolerance of the body and the perceived flaw of being fat. Some psychologists classify BDD as a form of obsessive complusive disorder. Keep in mind though, those same psychologists classify bulemia and anorexia as anxiety disorders. So how is BDD different from the general public’s malaise with their body?

“Many people are somewhat critical of their appearance, and some people will go to great lengths in attempt to change what they consider to be flawed. Plastic surgery is increasing in popularity, and more people are willing to take the risk of “going under the knife.” A specific aspect of appearance can be surgically altered or “corrected” through procedures such as rhinoplasty (or a “nose-job”). Many people who have had this procedure are happy with the results and can move on with their life. When, however, BDD is a factor, the nose will never be perfect — or if they are satisfied with the nose, another obsessive fixation on a different body part will take over.”

BDD occurs when the individual is so preoccupied with their perceived flaws that it impairs occupational and/or social functioning, sometimes to the point of severe depression and anxiety and development of other anxiety disorders. BDD, like ED, can be caused by biological, psychological or environmental factors, with many researchers linking BDD to abuse or neglect. Sue Jones, of yogaHOPE -www.yogahope.org – once summarized BDD as doing what most abuse survivors do – turning their feelings of being bad or unworthy – into concrete form. Instead of thinking “I am bad or unworthy inside” as many who suffer from addictions do, they those with BDD think “My body is bad or unworthy.”

In clinical terms, “body dysmorphic disorder (BDD) and anorexia nervosa are severe psychiatric illnesses involving perception of appearance. While there are differences and are treated as distinct disorders, they have many similarities including obsessive scrutiny of appearance features, possible perceptual distortions, and anxiety,” says Jamie Feusner, M.D.

The suicide rate for those with BDD is double that for those with depression, and some researchers state that suicidal thoughts are as common as occurring in 80% of those with BDD.

BDD is treated through therapy and medication – most likely cognitive behavioral therapy and selective serotonin inhibitors. Its interesting that there is little written about Yoga as a treatment for BDD. When asked about the relationship between the two, noted psychologist Kelly McGonigal stated “yoga helps by cultivating a healthy body image based on internal sensation and awareness, not one based on cognitive distortions.”

Articles like this http://www.observer.com/node/51695 in the New York Observer detail how many with BDD seek out yoga for the spiritual relief from the disorder and from related eating disorders. More scholarly articles note that

Modern psychological studies have shown that even slight facial expressions can cause changes in the involuntary nervous system; yoga utilizes the mind/body connection. That is, yoga practice contains the central ideas that physical posture and alignment can influence a person’s mood and self-esteem, and also that the mind can be used to shape and heal the body. Yoga practitioners claim that the strengthening of mind/body awareness can bring eventual improvements in all facets of a person’s life.

Others state that: “there are excellent treatments for BDD. One of them is cognitive-behavioral therapy (CBT) with uses exposure and response prevention. Also the addition of mindful awareness training, cognitive restructuring….” Eda Gorbis, PhD, MFCC Assistant Clinical Professor, UCLA School of Medicine.

Yoga is a form of mindful awareness training – a way to experience the body while in an anxiety free zone (or anxiety reduced zone) due to the deep breathing and conscious awareness fostered by the practice. Yoga and CBT are closely linked. CBT’s goals are to restructure the thinking patterns of the patient towards tolerance of anxiety provoking triggers. Yoga’s goal is to reduce the whirlpools of the mind, by changing behavior, perceptions and reducing automatic instant response cues (pratyahara).

Unlike the times where I normally say, “Yoga is so much more than the postures, its benefit to eating disorders comes from the sutras and other resources,” in treating BDD, it is the postures that assist in treatment. By providing a controlled environment where students can experience being present in their bodies, even for short periods of time yoga takes on many of the characteristics of CBT work. Classes are also beneficial to those with BDD because cues are given to breathe deeply, and to stay “on the mat”, giving students tools for handling the intolerance of certain feelings in the body – fullness in the stomach, width of thighs, etc.

In that way, yoga can be seen as a form of CBT and mindful awareness training at the same time. Given that BDD is chronic and worsens without treatment, it makes sense to advocate for any method of treatment that would be beneficial.

a reader suggested that I include information on body dysphoria and I found an excellent article discussing this topic on askmen.com so i’m inlcuding the introduction here because it is so common that I overlook how ED and ED related disorders have somewhat different characteristics in men.

what is body dysphoria?
To start, it’s important to clarify the relationship between body dysphoria and body dysmorphic disorder. Body dysphoria is used to describe general feelings of sadness or an uncomfortable mood. It can include feeling great anxiety, irritability or restlessness. The opposite of these feelings would be euphoria, which is characterized by feelings of elation and joy.

Body dysmorphic disorder, on the other hand, occurs when you have a preoccupation about some quality in your appearance. This negative view of yourself can lead to body dysphoria as feelings of sadness, low-self esteem and potentially even self-hate set in.

When it comes to eating disorders in relation to body dysphoria, those suffering tend to view themselves as being larger than they really are. They’ll look in the mirror and their mind will see an altered image looking back. This is one type of body dysphoria because perception of reality is distorted, and they experience extreme anxiety over how their body looks.

On the other hand, another type of body dysphoria more commonly seen in men is when looking in that same mirror the image looking back appears to be smaller, rather than larger.

These men see themselves as being “scrawny,” when their main goal is to become more muscular. They feel they don’t measure up to the standards of today and they are ashamed of their current body image. This altered image does not necessarily have to be strictly related to muscle mass either. The individual may feel their body is not proportioned correctly or they may find some other body part to feel ashamed of.

Once again, this is a distortion of reality and affects the way those suffering from body dysphoria think and feel about themselves.

Signs of body dysphoria
The specific signs of body dysphoria are unique to the individuals who are experiencing them; however, there are some common indications that a problem may be at work, and should be watched for.
-Frequent checking oneself in the mirror
-Constantly flexing the muscles in efforts to gauge progress levels
-Consuming vast amounts of foods in attempt to get larger
-Avoidance of going out because of the belief that one doesn’t look good
-Wearing large, baggy clothing to hide one’s appearance
-Spending an overabundance of hours in the gym, trying to bulk up
-Not taking compliments well
-Talking negatively about one’s appearance

It can sometimes be hard to spot the difference between body dysphoria and someone who is simply really dedicated to building muscle mass. The key trait to look for is that those with body dysphoria will really have an impacted self-esteem because of their image, and their mental state will be drastically affected. While the person who wants to build mass will make this mission important to them, it won’t start to affect other areas of their life. The individual with body dysphoria, however, may start avoiding public situations in order to hide what they believe to be a very negative appearance.

I suffered with BDD for years, along with EDNOS/bulimia/depression/SI. I never went to therapy to directly discuss the issue. (My original therapist who I saw off and on for 5 years said, “oh but you’re beautiful!” when I finally admitted that what I saw in the mirror was distorted, scary, and ugly. :/) I was also afraid to really talk about it because I didn’t want to hear, “no you don’t have BDD, unfortunately you are just ugly.”

I’ve never been so bad to have completely removed myself from society, but I have had days I’ve called in “sick” to work because I couldn’t bare to step out in the world and have people see me, I didn’t want to subject people to the appalling sight of me. I’ve also gone to the other extreme and done erotic modeling in an attempt to prove I’m not disgusting, even though I was sure I was.

I’ve been doing a lot of cognitive behavioral work on my own, and reading self-help-y books ;) as well as surrounding myself with positive/healthy people. Just last week I said “I’m pretty!” and BELIEVED IT. Huuuuuuuuuge deal. I don’t think I’ve ever done that before. Now I can look at pictures of myself and see me (I think). At least I don’t see a huge distorted blob, and my sight isn’t obscured by intense thoughts of hatred and shame. I still see the “imperfections” and sometimes I catch myself worrying about my face not being symmetrical, or that if I don’t wear my glasses my face will look creepy and weird… but I catch these thoughts, acknowledge them, and move on.

You go Girl! I just recently have realized or accepted that I have ED and on the looks of it other disorders. I can definetly relate to BDD and BD. I’m really intrested in reading more self help books…which books did you read?
And tell me more on how you do cognitive behavioral work on your own…

I have been wanting to enrol in a course in Yoga Therapy for months now, at http://www.wellpark.co.nz I have been suffering with an ED for years. My therapist doesn’t really comment on whether enrolling is a good idea or not. A friend of mine was doing this course to help her through the grief of the loss of a family member. It is a spiritual journey she said, she is just loving it and is feeling happy and loving herself.
I wasn’t sure if it was more ED behaviour similar to wanting to do a personal training course, I am sure it is different. There is a lot of theory involved and you learn how to love yourself during your studies.
I want to do it, and I want to go to India, and I want to be well and recover and your blog is just great. thanks